From Kaiser Health News - Latest Stories:

Expect more aggressive regulatory action from the Trump administration while skirmishes continue in Congress and statehouses across the country. Many of these policies will ultimately be challenged in court. (Julie Rovner,
1/9)

To get care for their 12-year-old son's severe mental illness, Toni and Jim Hoy had to give up custody of him and allow the state of Illinois to care for him. It happens to hundreds, perhaps thousands of children each year. The exact number is unknown because two-thirds of states do not keep track. (Christine Herman, Side Effects Public Media,
1/9)

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Summaries Of The News:

“We should be the guys and gals that are putting up things that make health care more affordable and more accessible,” said Jim McLaughlin, another Republican pollster. “No question Democrats had an advantage over us on health care." In other health new from Capitol Hill: short-term insurance plans, single-payer and gun control legislation.

The Hill:
GOP Seeks Health Care Reboot After 2018 Losses
Republicans are looking for a new message and platform to replace their longtime call to repeal and replace ObamaCare, after efforts failed in the last Congress and left them empty-handed in the 2018 midterm elections. Republican strategists concede that Democrats dominated the health care debate heading into Election Day, helping them pick up 40 seats in the House. (Bolton, 1/9)

The Hill:
Democrats Demand Answers On Trump Short-Term Insurance Plans
House and Senate Democrats want answers about the Trump administration’s decision to expand the availability of short-term insurance plans that are not required to meet ObamaCare requirements. The letter sent Tuesday is the third time Democratic health care leaders have written to the administration about the short-term plan proposal, but the first time since Democrats took control of the House. (Weixel, 1/8)

The Hill:
Dem Chairman Requests CBO Report On Design Of Single-Payer Bill
House Budget Committee Chairman John Yarmuth (D-Ky.) on Tuesday requested information from the Congressional Budget Office (CBO) about single-payer health care proposals, a step forward in consideration of the idea. In a letter to the CBO, Yarmuth requested a report on the “design and policy considerations lawmakers would face in developing single-payer health system proposals.” (Sullivan, 1/8)

The Fiscal Times:
Democrats Gear Up For Single-Payer Health Care Push
Speaker Nancy Pelosi (D-CA) said last week that she supports holding hearings on Medicare-for-All legislation, and on Tuesday House Budget Committee chair Rep. John Yarmuth (D-KY) sent a letter to the Congressional Budget Office requesting a comprehensive analysis of how a single-payer health system would work in the U.S. (Rainey, 1/8)

The New York Times:
Background Check Bill Marks Gun Control As A Priority For House Democrats
Emboldened House Democrats, seeking a politically charged debate on gun control, unveiled legislation on Tuesday to expand background checks to nearly all firearms purchases, a move timed to mark the eighth anniversary of the mass shooting in Arizona that nearly killed former Representative Gabrielle Giffords. By introducing the measure less than one week after taking control of the House, Democrats are signaling that it is a top priority. A vote could come within the first 100 days of the new Congress. (Stolberg, 1/8)

Although the FDA is officially continuing to oversee food recalls, monitoring for outbreaks, and can call staff back to work to address any emergency situations, FDA Commissioner Scott Gottlieb said that there is no question that "it is not business as usual" at the agency. Meanwhile, President Donald Trump says his border wall will help with the opioid crisis, but experts say it won't really be a deterrent for the flow of drugs into the country.

CNN:
FDA Employees Think Shutdown Could Be Deadly
With about 41% of the US Food and Drug Administration off the job due to the government shutdown, some agency employees worry about the safety and health of the American public. Agency operations "continue to the extent permitted by law," according to the FDA website, meaning "activities necessary to address imminent threats to the safety of human life and activities [are] funded by carryover user fee funds." (Yurkevich and Christensen, 1/8)

The Washington Post:
The White House Says The Border Wall Would Keep Opioids Out Of The U.S. It Wouldn’t.
When President Trump makes his case tonight that there really is a border crisis, he’ll probably mention the opioid epidemic ravaging the United States, which killed thousands of Americans last year. Trump and his surrogates often cite the drug crisis as a reason the border wall with Mexico is needed. There is a “massive influx of drugs that come across the southern border,” White House press secretary Sarah Sanders said Sunday during an interview on Fox News. “Ninety percent of the heroin that comes into this country comes across through the southern border and 300 Americans are killed from that every single month,” she told Fox’s Chris Wallace. (Itkowitz, 1/8)

Reuters:
Factbox: Impact On U.S. Government Widens On 18th Day Of Shutdown
A shutdown of about a quarter of the U.S. government reached its 18th day on Tuesday, with lawmakers and the White House divided over Republican President Donald Trump's demand for money for a border wall ahead of his prime-time address to push the project. The shutdown, which began on Dec. 22, is the 19th since the mid-1970s, although most have been brief. This one now ranks as the second-longest, with Trump saying it could continue for months or years, even as he said he hoped it was resolved within days. (1/8)

The New York Times:
As Government Shutdown Goes On, Workers’ Finances Fray: ‘Nobody Signed Up For This’
Tanisha Keller, a single mother who works for the federal Census Bureau, used to live paycheck to paycheck. Now, she is living nothing to nothing. Payday would have come this week for Ms. Keller, 42, and many of the 800,000 other federal workers across the country caught up in the partial government shutdown. But as the standoff drags on, no paychecks are arriving to replenish their savings or pay down their maxed-out credit cards. Ms. Keller’s bank balance has dipped to negative $169. She can no longer afford the $100 stipends she once sent to her son, Daniel, to help out with his college books and groceries. (Healy, Johnson and Taylor, 1/8)

The lawsuit seeks the creation of a fund to pay for mental health treatment for children separated from their parents. In arguing that the case should be thrown out, the Department of Justice also said that the government officials named are shielded by qualified immunity.

The Associated Press:
Trump Officials Seek Dismissal Of Separated Families' Suit
The federal government is urging a judge to throw out a lawsuit seeking monetary damages on behalf of children who were separated from their parents at the U.S.-Mexico border. U.S. Department of Justice attorneys said in a brief filed Tuesday that Supreme Court precedent bars such a lawsuit for damages on challenges to government policy. They also argue Trump administration officials named in the case are shielded by qualified immunity, among other things. (1/8)

In other news —

Texas Tribune:
Tornillo Tent City For Migrant Teens Is On The Verge Of Shutting Down
After more than six months of serving as a symbol of President Donald Trump’s hardline immigration policies, the detention center for young migrants at Tornillo is on the brink of closing for good. ...Critics decried the facility as a “tent city” after it was hastily erected, and its construction led to several protests organized by elected officials. At one time it held more than 2,500 undocumented minor immigrants who crossed the border seeking asylum. (Aguilar, 1/8)

The NYC Care plan, which Mayor Bill de Blasio said would be funded without tax increases, is an expansion of the city’s existing MetroPlus plan that covers hospital bills for low-income residents. “No one should have to live in fear. No one should go without the health care they need. Health care is a human right. In this city, we’re gonna make that a reality,” de Blasio said during a news conference. The plan would also cover immigrants who are living in the country illegally. Meanwhile, Washington Gov. Jay Inslee announced plans to offer residents a public option which would be a step toward single-payer health care.

The New York Times:
De Blasio Unveils Health Care Plan For Undocumented And Low-Income New Yorkers
New York City will spend at least $100 million to ensure that undocumented immigrants and others who cannot qualify for insurance can receive medical treatment, Mayor Bill de Blasio announced on Tuesday, seeking to insert a city policy into two contentious national debates. The mayor has styled himself, in his 2017 re-election campaign and during his second term, as a progressive leader on issues like education and health care, and as a bulwark against the policies of President Trump, particularly on immigration. (Goodman, 1/8)

Reuters:
New York City Launches $100 Million Universal Health Insurance Program
De Blasio, now in his second term as mayor of the country's most populous city, has long supported universal healthcare coverage. Extending the program to an estimated 300,000 illegal immigrants puts the Democrat at odds with U.S. President Donald Trump, who has made border security a top priority for his presidency. "No one should have to live in fear. No one should go without the health care they need. Health care is a human right. In this city, we're gonna make that a reality," de Blasio said during a news conference. "From this moment on in New York City, everyone is guaranteed the right to health care." (Cherelus, 1/8)

The Washington Post:
New York City Mayor Vows Health Care For All — Including Undocumented Immigrants
De Blasio’s $100 million commitment was laden with political significance: He delivered it hours before a prime-time speech by President Trump, who was expected to defend his assertion that the country faces a crisis of illegal immigration. “I refuse the notion that these folks don’t deserve health care,” the mayor said of undocumented immigrants. “It is not only the morally right choice, but it will save taxpayers in the end.” The initiative also coincides with the start of the 2020 presidential election cycle as calls for universal coverage — often called Medicare-for-all — are emerging as a rallying cry among potential Democratic aspirants. (Goldstein, 1/8)

The Associated Press:
Washington Governor, NY Mayor Push Expanded Health Coverage
Washington's governor and New York City's mayor unveiled major initiatives to expand health insurance coverage Tuesday, the latest moves by key Democratic leaders to address Trump administration health policies they say are keeping people from getting the care they need. Washington Gov. Jay Inslee, a likely presidential candidate, proposed a publicly run health insurance option for state residents who are not covered by private employers and buying insurance off the marketplace created under former President Barack Obama's health care law. "We need to write another chapter of health care reform," said Inslee, who provided no details on how the program would be funded. (Ho, 1/8)

The Hill:
Washington Governor Pushes Public Option Legislation
Reimbursement rates would be consistent with Medicare rates, Inslee said. “Under the Obama administration and the Affordable Care Act, Washington was able to make tremendous progress in expanding coverage and start bringing down costs in our health care system. Under the Trump administration, all that progress is at risk,” Inslee said in a statement. (Weixel, 1/8)

Sacramento Bee:
Gavin Newsom’s Health Plan Could Lower Your Insurance Costs
California’s new governor wants to reinstate the individual mandate at the state level. It’s part of a sweeping health care plan Gov. Gavin Newsom unveiled just hours after being sworn into office Monday. Here’s a breakdown of what the individual mandate is, what Newsom’s proposal means and how it might affect Californians. (Bollag, 1/9)

“The president’s been really clear — prices of drugs need to be coming down, not going up,” said HHS Secretary Alex Azar, who was reportedly a part of the meeting. Meanwhile, Democrats on Capitol Hill are looking to score some early wins with small drug pricing legislation.

Politico:
Trump Summons Advisers To White House Over Drug Price Hikes
President Donald Trump has summoned top officials for a White House meeting on drug prices, frustrated over a new round of price hikes after Trump promised to lower pharmaceutical costs, two individuals with knowledge told POLITICO. Health and Human Services Secretary Alex Azar, Council of Economic Advisers Chairman Kevin Hassett and acting White House chief of staff Mick Mulvaney are among officials set to meet with the president Tuesday, one individual said. (Diamond, Cancryn and Owermohle, 1/8)

Stat:
Allergan CEO: We Stuck To Spirit Of Our Social Contract With Recent Price Hikes
Earlier this month, numerous drug makers began raising prices after taking a hiatus last summer under political pressure from President Trump. Even so, the vast majority of recent price hikes were low single-digit increases, although there were a couple of notable exceptions. One was Allergan (AGN), whose chief executive, Brent Saunders, famously declared in September 2016 that his company would keep a “social contract” by ensuring price hikes — after paying rebates and discounts — would remain below double digits and not exceed inflation. (Silverman and Herper, 1/8)

The Hill:
Democrats Seek Early Victories On Drug Prices
Newly empowered House Democrats plan to move first on smaller, bipartisan legislation to lower drug prices, hoping to notch some early victories before moving on to more sweeping measures. Democrats have targeted a number of measures that are smaller in scope but have support from some Senate Republicans, according to Democratic sources. They hope taking a strategic approach and passing those measures will build momentum as they prepare to tackle more controversial proposals further down the road, like allowing Medicare to negotiate drug prices. (Sullivan, 1/9)

Prescription Drug Watch: For news on rising drug costs, check out our weekly roundup of news coverage and perspectives of the issue.

A new analysis of marketing data from the FDA, Medicare, other federal and state agencies, private companies and medical research finds a 69 percent increase, to $29.9 billion, over a recent 20-year period. "Marketing drives more treatments, more testing" that patients don't always need, said Dr. Steven Woloshin, a Dartmouth College health policy expert.

Stat:
Medical Marketing Exploded Since 1997, Raising Questions On Industry Influence
A sweeping analysis of medical marketing in the U.S. — from drug promotions aimed at consumers and physicians to disease awareness campaigns, hospital services, and laboratory testing — found a 69 percent increase, to $29.9 billion, over a recent 20-year period. But despite policies designed to limit industry influence over the health care system, there appeared to be insufficient regulatory oversight. The fastest rise in industry marketing was spent on direct-to-consumer ads, which increased from $2.1 billion, or 12 percent, of all marketing expenditures in 1997, to $9.6 billion, or 32 percent of total spending in 2016, according to the analysis in the Journal of the American Medical Association. (Silverman, 1/8)

The Associated Press:
US Medical Marketing Reaches $30 Billion, Drug Ads Top Surge
Ads for prescription drugs appeared 5 million times in just one year, capping a recent surge in U.S. medical marketing, a new analysis found. The advertisements for various medicines showed up on TV, newspapers, online sites and elsewhere in 2016. Their numbers soared over 20 years as part of broad health industry efforts to promote drugs, devices, lab tests and even hospitals. (Tanner, 1/8)

In a separate development, the San Carlos Apache Tribe issued a statement saying the woman involved in the case was a 29-year-old “enrolled member” who “has been in a persistent vegetative state and coma for over a decade.”

The New York Times:
Police Collect DNA From Nursing Home Workers After Sexual Assault Of Patient
The police collected the DNA of male employees of a private nursing home in Arizona on Tuesday as they continued to investigate allegations that a woman in a vegetative state there who gave birth to a child last month had been sexually assaulted, the nursing home’s parent company said. The move represented an escalation in the case, just one day after the longtime chief executive of the company resigned. The police in Phoenix announced Friday that they had opened the investigation into the alleged assault. (Stevens, Rueb and Kramer, 1/9)

The Associated Press:
Family Of Woman In Vegetative State Outraged After Baby Born
Police served a search warrant Tuesday to get DNA from all male employees at a long-term care facility in Phoenix where a patient who had been in a vegetative state for years gave birth, triggering reviews by state agencies and putting a spotlight on safety concerns for patients who are severely disabled or incapacitated. Hacienda HealthCare said it welcomed the DNA testing of employees. (Tang, 1/8)

With Justice Brett Kavanaugh on the court, the anti-abortion movement is eager to see cases move through the judicial branch. “Our agenda is very focused on the executive branch, the coming election, and the courts,” said Marjorie Dannenfelser, president of the anti-abortion organization Susan B. Anthony List. Abortion news comes out of Louisiana, as well.

Kaiser Health News:
Where Abortion Fights Will Play Out In 2019
With Democrats now in control of the U.S. House of Representatives, it might appear that the fight over abortion rights has become a standoff. After all, abortion-rights supporters within the Democratic caucus will be in a position to block the kind of curbs that Republicans advanced over the past two years when they had control of Congress. But those on both sides of the debate insist that won’t be the case. (Rovner, 1/9)

The Associated Press:
US Appeals Court Set To Hear New Orleans Abortion Case
A federal appeals court planned to hear arguments Wednesday on a lawsuit claiming the state of Louisiana is needlessly and illegally delaying a license enabling Planned Parenthood to perform abortions at a new facility in New Orleans. Louisiana officials are seeking dismissal of the lawsuit, which was filed in February by Planned Parenthood Gulf Coast and Planned Parenthood Center for Choice. U.S. District Judge John deGravelles in Baton Rouge refused to dismiss the case in May. The state appealed to the 5th U.S. Circuit Court of Appeals, which scheduled arguments for late Wednesday morning. (1/9)

The Hill:
Dem Lawmaker To Speak At Annual Anti-Abortion Rally In Washington
Rep. Dan Lipinski (D-Ill.), one of the few anti-abortion Democrats on Capitol Hill, will speak at the March for Life this month after skipping the annual event last year during a tough primary challenge. The Illinois lawmaker was scheduled to speak at last year's rally, but bailed following criticism from abortion-rights groups that supported his primary opponent, Marie Newman. (Hellmann, 1/8)

And in other women's health news —

The New York Times:
5 Reproductive Health Issues We Should Be Talking About
Premenstrual dysphoria. Pelvic floor disorders. Endometriosis. These can be serious health conditions for women, yet many of us are reluctant to discuss them, even with our doctors. In fact, the bulk of my knowledge on these and many other issues that affect women’s reproductive health have been passed along to me through word of mouth like some kind of lore. (Salam, 1/8)

A drop in lung cancer deaths is the main reason. A new government report also shows while the country has seen increases in fatalities from seven of the 10 leading causes of death, the cancer death rate has dropped 27 percent from the 1990s to 2016. But minorities and poorer people are not faring as well.

The Associated Press:
US Cancer Death Rate Hits Milestone: 25 Years Of Decline
The U.S. cancer death rate has hit a milestone: It's been falling for at least 25 years, according to a new report. Lower smoking rates are translating into fewer deaths. Advances in early detection and treatment also are having a positive impact, experts say. But it's not all good news. Obesity-related cancer deaths are rising, and prostate cancer deaths are no longer dropping, said Rebecca Siegel, lead author of the American Cancer Society report published Tuesday. (Stobbe, 1/8)

CNN:
US Cancer Death Rate Hits 25 Years Of Decline, Study Says
"The continued decline in the cancer death rate over the past 25 years is really good news and was a little bit of a surprise, only because the other leading causes of death in the US are starting to flatten. So we've been wondering if that's going to happen for cancer as well, but so far it hasn't," said Rebecca Siegel, first author of the study and strategic director of surveillance information at the American Cancer Society. (Howard, 1/8)

Bloomberg:
Cancer Mortality Rates In U.S. Decline For Wealthy Americans
The good news is that cancer in America was beaten back over the 25 years ending 2016, with death rates plummeting, particularly when it comes to the four most common types of the dreaded affliction. There’s a caveat, however. Those gains have been reaped mostly by the well-off. While racial disparities have begun to narrow, the impact of limited access to treatment for the poorest Americans has increased wealth-based inequality, according to the American Cancer Society’s annual update on trends and statistics. (Cortez, 1/8)

PBS NewsHour:
As Death Rates From Cancer Decline, Why Are Some Communities Faring Worse?
"There are large parts of the United States where adequate medical care, particularly adequate cancer care, requires people to travel great distances, or even getting screened for cancer. So we need to really take a very careful look at all of these issues. And I do think we need to make a national commitment. We all need to make a commitment, personal commitment, whether it be government, other organizations, the American Cancer Society among them. We need to take a careful look at this and figure out what we need to do to make the outcomes equal." (Yang, 1/8)

There's a dark history of lapses in ethics that have resulted in a greater knowledge of treatments and diseases. Experts take a look at just how researchers should weigh the risk factors of an experiment. In other public health news: weight loss, the flu, toxic chemicals in paint strippers, migraines, mental health and more.

CNN:
Unethical Experiments' Painful Contributions To Today's Medicine
Chinese scientist He Jiankui sent shockwaves around the world last year with his claim that he had modified twin babies' DNA before their birth. The modification was made with gene editing tool CRISPR-Cas9, he said, and made the babies resistant to HIV. Scientists from China and around the world spoke out about the experiment, which many say was unethical and not needed to prevent the virus. The scientist had also been warned by peers not to go down this path. He's experiments, which are still clouded with the uncertainty of his claims and his whereabouts, open a Pandora's box of questions around ethics in experiments with humans -- even though these dilemmas aren't new. (Amramova, 1/9)

Bloomberg:
23andMe Will Add Weight-Loss Advice To Its DNA-Testing Services
Consumer DNA-testing giant 23andMe Inc. plans to add new wellness offerings it hopes will help its customers shed a few pounds, but some genetics experts say the jury is still out on the science behind the products. On Tuesday, the Mountain View, California-based company announced a partnership with Lark Health, an artificial-intelligence coaching service that delivers personalized advice for weight loss and diabetes prevention via an app. Lark will allow customers to incorporate weight-related genetic data from 23andMe into its service. (Brown, 1/8)

The New York Times:
Mind May Trump DNA In Exercise And Eating Habits
Just in time to befuddle people who received genetic testing kits for the holidays, a new study finds that if you tell people that they have a genetic predisposition to certain health characteristics, such as a low capacity for exercise or a tendency to overeat, their bodies start to respond accordingly. Even if their DNA does not actually contain the gene variants in question. (Reynolds, 1/9)

Marketplace:
Flu Season Could Be Less Damaging, Experts Say
During last year’s season, an estimated 80,000 people died – the highest number in 40 years. And a million people were hospitalized. The Centers for Disease Control says flu rates across the country are high this year. Every year, the U.S. spends lots of money on vaccines and prevention, so how come flu still affects so many of us? (Beras, 1/9)

The Washington Post:
EPA Moves To Ban Toxic Paint-Stripper Chemical For Some — But Not All — Uses
In the past year, major retailers such as Lowe’s and Home Depot have pulled a toxic chemical used in paint strippers, methylene chloride, from their shelves. The families of those who have died after exposure to the substance have begged leaders of the Environmental Protection Agency to finalize a ban that the agency proposed on Jan. 19, 2017 — a day before President Barack Obama left office. And in May, then-EPA Administrator Scott Pruitt pledged to do just that. (Eilperin and Dennis, 1/8)

Stat:
IBM Isn't Retreating From Using Watson In Health Care, CEO Says
After a string of costly business failures in health care, IBM CEO Ginni Rometty on Tuesday insisted the company was not retreating from championing the potential of its Watson artificial intelligence capabilities to shake up the medical industry. “Watson Health is a very important part” of IBM’s business, Rometty told STAT in her first interview on the company’s health division since its manager left in October, after months of uneven financial performance. (Ross, 1/9)

The New York Times:
Botox May Help Prevent Migraines
Botox injections are approved to reduce the frequency of migraine headaches, but studies of their effectiveness have had mixed results. Now a review of studies has concluded that Botox has small but significant benefits, with few serious side effects. Researchers analyzed data from 17 studies, including 3,646 patients, that tested botulinum toxin injections against placebos. More than 86 percent of the patients were women, and 43 percent had chronic migraines, with more than 15 headache days a month. The analysis is in Plastic and Reconstructive Surgery. (Bakalar, 1/8)

Kaiser Health News:
To Get Mental Health Help For A Child, Desperate Parents Relinquish Custody
When Toni and Jim Hoy adopted their son Daniel through the foster care system, he was an affectionate toddler. They did not plan to give him back to the state of Illinois, ever. “Danny was this cute, lovable little blond-haired, blue-eyed baby,” Jim said. Toni recalled times Daniel would reach over, put his hands on her face and squish her cheeks. “And he would go, ‘You pretty, Mom,’ ” Toni said. “Oh, my gosh, he just melted my heart when he would say these very loving, endearing things to me.” (Herman, 1/9)

The technology has been adapted to provide fast information that help inform patient treatment, doctors say. News on the opioid epidemic comes out of Pennsylvania and New Hampshire, as well.

Houston Chronicle:
Texas Hospitals Adapt Existing Technology To Tackle Opioid Crisis
Adapting existing technology, the Texas Hospital Association is helping health care providers fight the state's opioid epidemic through giving them better information when they need it. More than 85 percent of acute-care hospitals and health care systems in Texas are members in THA. In 2018, some members began using a Smart Ribbon technology to provide physicians with just-in-time information when they are treating patients. (Maness, 1/8)

New Hampshire Union Leader:
Opening The Doorway To Recovery: State Unveils Treatment Plan
When New Hampshire was awarded nearly $46 million in federal funding to combat the opioid crisis, DHHS officials decided to create a community-based system of care based on Vermont’s successful hub-and-spoke model. The hubs are tasked with coordinating care “to ensure people are getting the right services in the right location at the right time,” Meyers said. [Peter] Evers, who is also vice president for behavioral health at Concord Hospital, said when his two organizations heard about plans to create regional hubs that would serve as access points and refer clients to “spokes” in their local areas for treatment services, “We were all in.” (Wickham, 1/8)

Atlanta Journal-Constitution:
Health Care Could Be Big Issue In Georgia Legislature
The flow of hundreds of millions of health care dollars through Georgia could be routed one way or another, depending on what the General Assembly does on two issues in state law that have long percolated and now are on the front burner. One is whether to lift a statewide hospital regulation, and the other involves insurance for those who can’t afford it. (Hart, 1/8)

Boston Globe:
Insurer Agrees To Cover People Who Use HIV-Prevention Medication
The insurer Mutual of Omaha has agreed to stop refusing to provide certain types of coverage to Massachusetts residents who take a medication that prevents HIV, amid allegations of discrimination in two separate legal settlements announced Tuesday. In an agreement with Attorney General Maura Healey, the company said it had discontinued the practice of denying life insurance and long-term-care insurance to people who take Truvada, a daily medication that prevents transmission of HIV. (Freyer, 1/8)

KCUR:
Missouri Auditor Finds Changes To Home Health Care Saved Far Less Than Expected
Controversial changes to Missouri's home health-services program by former Gov. Eric Greitens and the Republican-controlled legislature saved one fourth of the $43 million lawmakers had expected, according a state audit. The Republican governor and state lawmakers didn’t take rising costs and sicker patients into account, concluded the report from State Auditor Nicole Galloway, a Democrat. Home-based services allow patients to stay out of nursing homes and keep a portion of their independence. (Fentem, 1/8)

The Associated Press:
2 More Flu-Related Deaths Bring Delaware Toll To 5
Public health officials say two more people have died from the flu in Delaware, bringing this flu season’s death toll in the state to five. The News Journal reports the Division of Public Health announced Monday a 51-year-old Kent County woman and a 55-year-old New Castle County woman had died. Both women were infected with Influenza A and had other, underlying health conditions. Authorities announced the first three flu-related deaths Jan. 2. The 65-year-old man, 73-year-old man and 77-year-old woman were all infected with Influenza A. (1/8)

Modern Healthcare:
Providence St. Joseph Health's Venture Capital Fund At $150 Million
Providence St. Joseph Health leaders took advantage of their stage time at the J.P. Morgan Healthcare Conference in San Francisco on Tuesday to unveil a second $150 million healthcare venture fund. The Renton, Wash.-based health system's venture capital arm, Providence Ventures, will use the fund, called Providence Ventures II, to target early and growth-stage companies focused on information technology, technology-enabled services, medical devices and healthcare services. (Bannow, 1/8)

Concord Monitor:
DHHS Pushes Back After Hospital Association Joins Suit Over Psychiatric Care
Department of Health and Human Services Commissioner Jeffrey Meyers criticized the New Hampshire Hospital Association for joining a lawsuit accusing the state of failing to provide timely care to psychiatric patients by keeping them in emergency rooms. “At a time when the state is dedicating itself to rebuilding its mental health system, including significant investments and a new 10-Year Mental Health Plan, it’s disappointing to see hospitals use a lawsuit to walk away from the table, not be part of the solution, and not provide responsible care and services sufficient to meet the needs of the populations they serve,” Meyers said in a statement. (1/8)

San Francisco Chronicle:
Nurse Accuses Zuckerberg SF General Hospital Of Retaliation After Push For Name Removal
A nurse at Zuckerberg San Francisco General Hospital who has urged hospital administrators to drop Facebook founder Mark Zuckerberg’s name from the institution said he filed complaints with state and federal labor boards Tuesday, accusing the hospital of retaliating against him for opposing the Zuckerberg name. The nurse, Sasha Cuttler, retained Washington, D.C., attorney Debra Katz to file the complaints with the U.S. Department of Labor’s Occupational Safety and Health Administration and the California Department of Industrial Relations. (Ho, 1/8)

Boston Globe:
Against The Odds, Tiny Waltham Biotech Strives To Improve Dialysis Patients’ Lives
As the world’s leading biotech executives descended on the annual J.P. Morgan Healthcare Conference this week to talk about gene editing, precision medicine, and other cutting-edge treatments, the folks at tiny Waltham-based Proteon Therapeutics came to promote a less sexy goal. They want to prevent the vein that surgeons create in the arm of kidney patients on dialysis from clogging. (Saltzman, 1/8)

The CT Mirror:
Access Health Sees Decline In Black And Hispanic Customer Base
With just one week left in open enrollment, Access Health CT has seen overall high levels of customer engagement and turnout, but a decline in its black and Hispanic base, a health insurance exchange official told Connecticut policymakers Tuesday. Connecticut’s Affordable Care Act marketplace expanded its enrollment period for people seeking coverage in 2019 to Jan. 15. (Silber, 1/8)

Texas Tribune:
State Auditor: Texas Agencies Lost Nearly 29,000 Employees Last Year
State Auditor’s Office report released in December found that agency turnover was at 19.3 percent in the 2018 budget year. Auditors said the rate is based on 28,684 employees who voluntary and involuntary left their jobs that year. The top reasons employees said they left were retirement, better pay and benefits and poor working conditions or environments. (Evans, 1/8)

Boston Globe:
Cambridge Advances Proposal To Add Gender-Neutral Option To City Birth Certificates
Cambridge officials Monday advanced a proposal to add a gender-neutral option to birth certificates issued in the city while letting those who don’t identify with the gender assigned to them at birth amend the document without having to jump through certain administrative hoops. The policy order, which was introduced this month by Mayor Marc McGovern, was passed unanimously by the City Council during the first meeting of the New Year Monday night. (Annear, 1/8)

KQED:
State Launches Probe Into 100,000-Gallon Marin County Sewage Spill
California water quality regulators are investigating an incident in San Anselmo on Sunday that caused at least 100,000 gallons of raw sewage to spill out of manholes in the city. The spill took place during a rainstorm that overwhelmed a Ross Valley Sanitary District sewer improvement project, sending sewage onto portions of Sir Francis Drake Boulevard, Broadmoor Avenue and Morningside Drive. (Goldberg, 1/8)

Health News Florida:
Key Lawmaker Expects Change In Marijuana Policy
One of the architects of Florida’s medical-marijuana laws anticipates a “new day in Florida” on marijuana issues after Gov.-elect Ron DeSantis takes over Tuesday as the state’s chief executive. DeSantis, a former congressman closely tied to President Donald Trump, “is going to embrace issues of access and patient care,” according to state Senate budget chief Rob Bradley, R-Fleming Island. (Kam, 1/7)

Boston Globe:
Social Marijuana Consumption, Home Delivery Up For Discussion
embers of the Cannabis Advisory Board’s public safety subcommittee, which includes law enforcement, marijuana consumer advocates, and municipal lobbyists, will discuss their recommendations for the Cannabis Control Commission, the five-member state body responsible for enacting policies. In 2017, the commission drafted delivery and social consumption regulations but decided last year to postpone licensing such businesses after Governor Charlie Baker and others raised concerns. (Martin, 1/8)

The Washington Post:
Insulin Is A Lifesaving Drug, But It Has Become Intolerably Expensive. And The Consequences Can Be Tragic.
At first, it seemed like the stomach flu. Weeks before his 24th birthday in May 2015, Alec Raeshawn Smith was overcome by troubling symptoms. His body ached, his stomach hurt and he wasn’t sleeping well. Laine Lu, a co-worker at his restaurant job, urged him to see a doctor. “This is not normal,” she recalls telling him. “Go get checked out.” His mother, Nicole Smith-Holt, worried too. He called her when he decided to go to a health clinic near Minneapolis. He said, “Seriously, Mom, I think something is really wrong with me.” (Stanley, 1/7)

The Washington Post:
New Congress: Democrats Look To Unlikely Ally On Drug Pricing In Donald Trump
Prescription drug companies and their legions of Washington lobbyists are strapping in for their rockiest year on Capitol Hill in at least a decade, as newly empowered House Democrats prepare a raft of bills to check U.S. drug prices. Democrats surged to power in the 2018 midterm House elections promising to protect Americans from ever-increasing prescription costs. They are buoyed by populist anger in individual states and a potential — if unpredictable — ally on the issue in the White House. (Rowland, 1/4)

Stat:
Vermont Projects Modest Savings From A Plan To Import Drugs From Canada
As Washington grapples with rising drug costs, the state of Vermont is edging closer to adopting a program that would designate wholesalers to buy medicines from across the border in Canada. The Vermont Agency for Human Services late last week completed a report showing the scheme could save up to $5 million annually on just 17 medicines for which two of the state’s three commercial health insurers spent the most money earlier this year. The forecast included a potential 45 percent mark-up on medicines. (Silverman, 1/7)

Stat:
Price Hikes On Existing Medicines Account For Lion's Share Of Higher Drug Costs
Amid intensifying debate over the rising cost of medicines, drug makers are often criticized for regularly raising prices, a tactic that sparks outrage given that the actual value of the drugs remains unchanged. Now, though, a new study of manufacturers’ list prices has quantified the extent to which price hikes have not only raised costs in recent years, but have also outpaced inflation by leaps and bounds. (Silverman, 1/7)

NPR:
Drug Costs Driven Largely By Price Increases, Not Innovation
The skyrocketing cost of many prescription drugs in the U.S. can be blamed primarily on price increases, not expensive new therapies or improvements in existing medications as drug companies frequently claim, a new study shows. The report, published Monday in the journal Health Affairs, found that the cost of brand-name oral prescription drugs rose more than 9 percent a year from 2008 and 2016, while the annual cost of injectable drugs rose more than 15 percent. (Kodjak, 1/7)

Stat:
California Governor Moves To Bolster Negotiating Power For Lower Drug Prices
In what is being billed as a first-of-its-kind move, California Gov. Gavin Newsom signed an executive order calling for state officials to negotiate prescription drug prices on behalf of the 13 million people covered by Medi-Cal, the state Medicaid program, and allow private insurers to participate as well. Currently, prescription drug purchasing for all but 2 million Californians is currently handled by private insurers that run managed care plans for the state program. Negotiations will now be handled by the state Department of Health Care Services and all state agencies are directed to purchase drugs together. (Silverman, 1/8)

The Wall Street Journal:
Biotech Proposes Paying For Pricey Drugs By Installment
A Boston-area biotech says it may have a found a way to handle the expected seven-figure cost of its experimental gene therapy: paying on installment. Bluebird Bio Inc. is developing plans to sell its first gene-replacement therapy, for a rare inherited blood disease, on a five-year installment plan, with each annual payment contingent on its treatment’s continued effectiveness. (Walker, 1/8)

Boston Globe:
For Biotech, 2019’s Not A Sky’s-The-Limit Year
The stock market’s sharp decline in the last quarter of 2018 has many Americans worried. But the tumble was particularly brutal for the state’s high-flying biotech sector, which relies on investors’ appetites for risky ventures that take years to yield new medicines — and often never do. (Saltzman, 1/7)

The Associated Press:
Eli Lilly Giving Price Info On Advertised Drugs Via Website
Drugmaker Eli Lilly has started posting price information online for drugs advertised on TV. On Tuesday, the company began running TV ads for a popular diabetes drug that don't give the price but direct viewers to the website. The site gives Trulicity's monthly list price of $730.20, the average out-of-pocket costs based on insurance and details on financial assistance programs. (Johnson, 1/8)

The Washington Post:
Should You Switch To A Mail-Order Pharmacy? Here Are The Factors To Consider
CVS does it. Walgreens does it. Now Amazon is getting in on the act. They’re all dispensing drugs by mail. With nearly 3 in 5 American adults taking at least one prescription drug, odds are your health insurer has steered you toward a mail-order pharmacy. And, if they haven’t, they probably will soon. "It’s all about convenience. You don’t have to leave home or wait in long lines. Plus, it’s easy to get all your medication refilled and shipped at one time and is usually more affordable,” says Mohamed Jalloh, a pharmacist and the official spokesman for the American Pharmacists Association. (Daily, 1/8)

NPR:
Temperature Extremes May Threaten Some Mail-Order Meds
Take a look at your prescription bottles. Most say, "Store at room temperature" or "Keep refrigerated." But what happens when drugs are delivered by mail? Were those instructions followed as the medicine wended its way from the pharmacy to your doorstep? Those questions haunt Loretta Boesing, who lives in Park Hills, a small town in the hills of eastern Missouri, where weather can vary dramatically from season to season. (Smith, 1/7)

Stat:
Sanofi To Exit Immuno-Oncology Collaboration With Regeneron
The days of Regeneron’s broad immuno-oncology collaboration with Sanofi are numbered. The two companies agreed to wind down a partnership, launched in 2015, sooner than is strictly necessary, they announced Monday. Sanofi will pay out the rest of its committed investments plus termination fees — about $460 million. Originally, the deal was set to expire in 2020, but included an option to extend certain programs for up to three more years. (Sheridan, 1/7)

Columbus Dispatch:
CVS Buying Ohio Pharmacy Chain, Closing All But Three
Ritzman stores in Akron and Berlin will continue operating with the same staff, but now under the CVS name, a statement by Ritzman said. Also, the chain will end its participation in a pharmacy at Northeast Ohio Medical University, which will review how it will handle its pharmacy business. (Schladen, 1/7)

The CT Mirror:
Pharma Cash Flows To Doctors For Consultant Work Despite Scrutiny
The financial relationships between pharmaceutical and medical device companies and doctors, as well as teaching hospitals, have been disclosed since 2013, under the Affordable Care Act. The law is intended to provide transparency into the business connections between health care providers and the industry. The law is also driving some doctors—like infectious diseases specialist Dr. Roger Echols of Easton—to give up their license to practice medicine. (Srinivasan, 1/6)

Stat:
In A Slump, Moderna Makes The Case For Its Big-Money Valuation
Moderna Therapeutics had record-setting success raising money from private investors, but the much-discussed biotech has struggled to convince the public markets of its industry-upending potential, and its stock price has slumped nearly 30 percent in the weeks following what was biotech’s largest-ever initial public offering. That left Moderna CEO Stéphane Bancel, speaking before a standing-room crowd at the industry’s premiere gathering on Tuesday, with a curious task: convincing investors that his $5 billion company is actually undervalued. (Garde, 1/8)

Stat:
With Approval For New Drug, Alexion Aims To Switch Patients From Soliris
Alexion Pharmaceuticals secured approval Friday from the Food and Drug Administration for a new drug called Ultomiris that will be used to treat an ultra-rare blood disease and ultimately replace the biotech’s current blockbuster, Soliris. The initial Ultomiris approval granted by FDA is to treat patients with paroxysmal nocturnal hemoglobinuria, or PNH — a rare, inherited disease in which red blood cells are destroyed by over-activation of the complement system, a part of the body’s immune system. (Feuerstein, 12/21)

Reuters:
GlaxoSmithKline To Look For Early-Stage Assets-CEO
GlaxoSmithKline Plc will actively look to buy early-stage assets and partner with companies, the drugmaker's chief executive officer said on Tuesday. Britain's biggest drugmaker is also likely to evaluate licensing deals and would continue to invest in early-stage HIV treatments, CEO Emma Walmsley said at the JP Morgan healthcare conference in San Francisco. (1/8)

USA Today:
Prescription Drug Costs Could Drop In 2019 Amid Momentum For Changes
Health care affordability ranks first or second among issues voters want Congress to tackle in 2019, according to numerous polls following the 2018 midterm elections. While Democrats and Republicans have very different opinions on hot button issues such as the Affordable Care Act and Medicare for All, they unite when it comes to anger over pharmaceutical costs.President Donald Trump has a plan to cut prescription drug prices, Democrats of all stripes have campaigned on tackling this. Should we expect to see big changes this year? As a 25-year veteran of the drug-pricing battle on Capitol Hill, I’m skeptical anything ambitious will be coming. Even so, there’s new momentum for change. Here are my predictions for action on drug pricing in the new 116th Congress. (Ted Slafsky, 1/7)

Stat:
Nominal Pricing Can Let Prisons And Jails Affordably Treat Hepatitis C
Across the United States, about 1 of every 7 individuals in jail or prison has chronic hepatitis C. In some states, such as New Mexico, it’s closer to 1 in 3. With approximately 9 million people spending time in prison or jail over the course of a year, more than 1.2 million incarcerated individuals have chronic hepatitis C. Left untreated, this viral disease can cause serious and costly health problems, including cirrhosis, liver cancer, liver failure, and even death. Once a difficult-to-treat infection, chronic hepatitis C can now be cured by taking a regimen of daily pills for eight to 12 weeks that act directly against the virus. But there’s a hitch: This cure costs $25,000 or more per person. (Anne C. Spaulding and Jagpreet Chhatwal, 1/9)

The Wall Street Journal:
The Drug Price-Control Threat
For all the nasty partisan divisiveness in Washington, it’s often worth worrying more when both parties agree. A case in point is a potential left-right condominium on drug prices that should alarm Americans hoping a cure for cancer or Alzheimer’s arrives in their lifetime.Members of Congress are calling prescription drug prices a top target for 2019. A GOP Senate in most cases will check the ambitions of Democrats in the House, but pharmaceuticals may be the exception. GOP Senator Chuck Grassley appears eager to investigate drug companies from his new post running the Senate Finance Committee. President Trump is demanding better deals on drugs, and the risk is that this crowd comes to a consensus. (2/7)

The Hill:
To Lower Drug Costs In 2019, Ignore Elizabeth Warren
Will 2019 be the year that lawmakers finally address prescription drug prices? Not if they follow distracting and counterproductive proposals like the one made by Democratic presidential primary candidate Sen. Elizabeth Warren (D-Mass.) last month to get the government into the drug manufacturing business. Warren's Affordable Drug Manufacturing Act would create an Office of Drug Manufacturing that would manufacture select generic drugs at a "fair price." (Terry Wilcox, 1/4)

The Wall Street Journal:
Price Drugs According To What They Do
In the U.S., medications are priced and sold by the pill, capsule or fluid ounce. A better approach would be to charge different prices for a medicine based on the disease for which it is prescribed. While the current drug-purchasing system is too complex to reform overnight, there is a simple change that could improve health outcomes and control spending: disease-specific rebates. Take a drug that wipes out malignant cells in lung cancer but is inconsistent in its ability to kill pancreatic cancer cells. In a world of “indication based” rebates, the manufacturer would pay the insurer or pharmacy benefit manager an agreed-upon amount each time the medication is used to treat a patient with pancreatic cancer. (Roger D. Klein, 1/8)

The Baltimore Sun:
Want Cheaper Drugs? Support Generics In Md.
A recent commentary (“Supreme Court must right wrong striking down Md.'s drug price-gouging statute,” Jan. 4) provides a guide to why patients are still frustrated about the state of drug prices, but not as the author intended. When the writer of the op-ed — like the drafters of Maryland’s generic drug legislation — myopically focuses on the “the Martin Shkrelis of the pharmaceutical industry,” he loses sight of what is driving high costs for patients: expensive brand-name drugs. (Chester Davis, 1/8)

Mankato Free Press:
Drug Companies Are Killing Us With High Prices
For more than four decades, well-meaning members of Congress of both parties have attempted to introduce competition into the prescription drug monopoly and for 40 years, they've been stymied and stone-walled by the powerful drug companies and their lobbyists. Minnesota Democratic Sen. Amy Klobuchar and Iowa Republican Sen. Charles Grassley have mounted another campaign with a proposal to prohibit pay-for-delay deals between drug companies that keep competitively priced general drugs and new medicines off the market. (1/9)

Los Angeles Times:
Gavin Newsom Is Already Moving California Toward Single-Payer
Gavin Newsom backed an assortment of ambitious and expensive programs as he campaigned for governor, none more so than the idea of converting the state to a single-payer healthcare system. On his first day in office Monday, Newsom reaffirmed that goal, but set the state on a more measured — and far more achievable — path toward insuring all Californians. The most dramatic step Newsom took was also the one least likely to bear fruit: He signed a letter asking the federal government’s permission to mingle federal dollars (such as funding for Medicare, Medicaid and veterans health benefits) and state funds into a single-payer system, replacing the various public and private insurance programs with one run by Sacramento. The chances of the Trump administration signing on to such a plan seem more remote than the most distant star in the Milky Way. (1/9)

Daily Herald:
A Physician's Case For A Single-Payer Health Care
Shane Patrick Boyle, a Type 1 diabetic living in Texas, had to move to Arkansas to care for his sick mother. His health insurance did not provide coverage in that state, so he set up a GoFundMe page to help cover his medical expenses until he could obtain new insurance. He got within $50 of his goal, rationing his insulin until he could obtain more. Then he died from complications of his diabetes. This tragedy and many others like it demonstrate some of the many failings of American health care. (John Perryman, 1/8)

Axios:
The Detail That Could Make Medicare For All Generous — And Expensive
Now that the Democrats have taken control of the House, their "Medicare for All" proposals are going to get hearings and scrutiny. One feature of Bernie Sanders' version that hasn't gotten a lot of attention yet, but it will: the plan has no deductibles or other forms of patient cost-sharing. Why it matters: In a country where so many Americans are bedeviled by medical bills, especially people who are sick and use a lot of medical care, this would be a big deal. It would actually make our system more generous than any of the other developed nations that Democrats like to cite as models for our own. Details: It may be surprising, but no other developed nation has zero out of pocket costs — even those that treat health care as a basic human right, as Medicare for All supporters want to do. That’s because their national health plans have cost-sharing, or allow people to purchase health care outside the plan, or both. (Drew Altman, 1/9)

The Lund Report:
Oregon Needs Significant Change To Achieve Universal Health Insurance Coverage
News from the “Universal Access to Health Care” workgroup wasn’t all bad. But those expecting revolutionary salvation for Oregon’s faltering health care system found the report peppered with cautionary phrases:“ Oregon’s current health-care system is not compatible with a state-based universal health care system;”“…new governance models and incremental design considerations …could result in significant disruption and unintended consequences to the existing system.”“…the work group did not achieve consensus on any of the policy approaches.” Daunting. But meriting attention within this remarkable report are several good ideas we should consider and a few bad ones we should not. (Samuel Metz, 1/8)

Stat:
We Are Caring For A New Type Of Patient: The Climate Migrant
As part of the Migrant Clinicians Network, my colleagues and I have treated many kinds of migrant over more than two decades: a farm worker who needs prenatal care who must travel every three weeks with the harvest; an asylum seeker struggling with insulin-dependent diabetes who is trying to escape war and violence; an immigrant who needs to travel back home in the midst of his tuberculosis treatment. But we are beginning to see a new type of patient — climate migrants — who I fear we will be seeing more of in the years to come, especially as the Trump administration seems to be ignoring the effects of climate change. (Ed Zuroweste, 1/9)

The Hill:
Should We Build A Border Wall Or Fund Research That Saves Millions Of Lives?
The U.S. government entered a partial shutdown shortly before Christmas, in large part due to a lack of resolution about President Trump’s $5.7 billion demand for a border wall. Lost in the conversation is how the closure of governmental agencies affects the scientific infrastructure of our country — and the health and safety of our citizens. (Andrea C. Gore, 1/8)

Bloomberg:
Gun Politics: Universal Background Checks Get A Welcome Push
Now leading a highly polarized House of Representatives, Speaker Nancy Pelosi has zeroed in on one issue that commands broad public support: requiring background checks on all gun sales. Eighty-five percent of American adults — including 79 percent of Republicans — support them for private sales and at gun shows, a recent survey shows.The House Democrats’ new legislation to require these checks should be considered and passed without delay. (1/8)

The Hill:
Hospital-Based Physicians Play A Key Role In Ending The Opioid Epidemic
The Drug Enforcement Administration’s recently released 2018 National Drug Threat Assessment estimates that opioids killed roughly 200 people a day in 2017. Despite efforts across the country to halt the national opioid epidemic, we continue to see deaths. Hospital-based physicians have a unique opportunity to identify innovative programs and proven practices that prevent and treat addiction in isolated pockets of the healthcare system and bring them to scale. (Rebecca Parker, 1/8)

The Washington Post:
What If We Paid People To Donate Their Kidneys To Strangers?
What if a simple policy could save tens of thousands of people every year from a deeply unpleasant treatment followed by early death? A policy that would disproportionately help the most disadvantaged? While actually saving taxpayer money? That’s a pretty rare combination; presumably you’d be pretty excited. But what if the policy involved paying people to donate one of their kidneys to a stranger? (Megan McArdle, 1/8)

The New York Times:
Coming Out As Trans Isn’t A Teenage Fad
Unfortunately, what many other parents are receiving right now is not encouragement to find wisdom and understanding. What they are getting instead is a bogus new diagnosis — Rapid Onset Gender Dysphoria. The inventors of this spurious term claim that R.O.G.D. is not a real trans identity but the product of social pressure. Abigail Shrier, writing in The Wall Street Journal, describes it as “social contagion.” She says that young people — many of them college-aged, and most of them born female-bodied — are embarking upon transition, with its surgeries and hormones and other accompanying challenges, in the same way a person might take up the ukulele. (Jennifer Finney Boylan, 1/8)

USA Today:
Why Doesn't Legal Marijuana Come With Warning Labels?
In his inaugural address on Jan. 1, New York Gov. Andrew Cuomo, like other governors, announced that he will push for the legalization of recreational marijuana, but he said nothing about what he will do to mitigate the health risks. Before legislators legalize marijuana, they should require bold and direct warning labels to be placed on the packaging as is done with tobacco products. If the states fail to act, then the Food and Drug Administration should step in and require it. (DJ Jaffe, 1/8)

The New York Times:
After Birth: How Motherhood Changed My Relationship With My Body
The mental and physical impact of going through pregnancy, giving birth and then dealing with a newborn is immense and can feel overwhelming. Whether you’re battling with stretch marks, hair loss or an inability to control your bowel movements, every woman’s experience of post-birth recovery is valid. Hopefully starting an honest dialogue free from shame, guilt or judgment — as I’ve tried to do here in this film — will benefit future mothers. (Bronwen Parker-Rhodes, 1/8)